Rivaroxaban for Inherited Thrombophilia and Stroke

A report describes a case of a 6-year-old boy who presented after an episode of focal seizure and acute-onset right hemiparesis. Examination revealed the child as dull with dense right hemiparesis (power- 1/5 in the right upper and lower limb). The child had no history of trauma, fever, or cardiac disease. 

Brain MRI showed acute ischemic infarct affecting the brainstem and right medial occipital lobe. Magnetic resonance angiography (MRA) of the intracranial vessels showed total occlusion of the distal 1/3rd of the basilar artery. The findings indicated the diagnosis of posterior circulation stroke. 

The child received an injection of enoxaparin, which was continued for 12 wk. At 12th week follow-up, Stroke work-up showed homozygous MTHFR mutation (A1298C) and protein-C deficiency. Rest of the pro-coagulant work-up and echocardiography were unremarkable.

Considering inherited hemophilia, the patient needed long-term anticoagulation. Hence, after a hematology consultation, tablet rivaroxaban (5 mg daily) was started. The patient tolerated the drug well, and showed no recurrence at six months of starting the drug.

Gupta J, Garhwal P, Sharma V, et al. Rivaroxaban in a Child with Inherited Thrombophilia and Stroke — New Kid on the Block. Indian J Pediatr. 2024. https://doi.org/10.1007/s12098-024-05191-1